<script src="<?php echo base_url(); ?>script/js/jquery.validationEngine-en.js" type="text/javascript" charset="utf-8"></script>
<script src="<?php echo base_url(); ?>script/js/jquery.validationEngine.js" type="text/javascript" charset="utf-8"></script>
<script>
$(document).ready(function(){
    $("#purchase-registration").validationEngine('attach');
}); 
</script>
<div id="content">
    <div id="left-box">
    </div>
    <div id="mycart-container">
        <div id="mycart-breadcumb">
            <h1>
                <a href="<?php echo base_url(); ?>cart">Checkout</a> > Registation Form
            </h1>
        </div>
        <div id="mycart-list">
            <form id="purchase-registration" action="<?php echo base_url(); ?>cart/submit" method="post">
                <table id="mycart-table-reg">
                    <tr id="mycart-reg-header">
                        <th colspan="3">CONTACT DETAILS</th>
                        <th></th>
                        <th colspan="3">SHIPPING ADDRESS</th>
                    </tr>
                    <tr>
                        <td colspan="7">
                            <div class="_blank" style="height:4px;"></div>
                        </td>
                    </tr>
                    <tr>
                        <td colspan="3"><img src="<?php echo base_url(); ?>images/cart-reg-line.png"/></td>
                        <td></td>
                        <td colspan="3"><img src="<?php echo base_url(); ?>images/cart-reg-line.png"/></td>
                    </tr>
                    <tr>
                        <td colspan="7">
                            <div class="_blank" style="height:4px;"></div>
                        </td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">FIRST NAME</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="first_name" class="validate[required]" id="field-reg-name"/>
                        </td>
                        <td class="mycart-reg-separator"></td>
                        <td class="mycart-reg-field">FIRST NAME</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="first_name_s" class="validate[required]" id="field-reg-name_s"/>
                        </td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">LAST NAME</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="last_name" class="validate[required]" id="field-reg-last"/>
                        </td>
                        <td class="mycart-reg-separator"></td>
                        <td class="mycart-reg-field">LAST NAME</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="last_name_s" class="validate[required]" id="field-reg-last_s"/>
                        </td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">ADDRESS</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <textarea name="address" class="validate[required]" id="field-reg-address"></textarea>
                        </td>
                        <td class="mycart-reg-separator"></td>
                        <td class="mycart-reg-field">ADDRESS</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <textarea name="address_s" class="validate[required]" id="field-reg-address_s"></textarea>
                        </td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">CITY</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="city" class="validate[required]" id="field-reg-city"/>
                        </td>
                        <td class="mycart-reg-separator"></td>
                        <td class="mycart-reg-field">CITY</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="city_s" class="validate[required]" id="field-reg-city_s"/>
                        </td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">STATE</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="state" class="validate[required]" id="field-reg-state"/>
                        </td>
                        <td class="mycart-reg-separator"></td>
                        <td class="mycart-reg-field">STATE</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="state_s" class="validate[required]" id="field-reg-state_s"/>
                        </td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">COUNTRY</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="country" class="validate[required]" id="field-reg-country"/>
                        </td>
                        <td class="mycart-reg-separator"></td>
                        <td class="mycart-reg-field">COUNTRY</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="country_s" class="validate[required]" id="field-reg-country_s"/>
                        </td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">POSTAL CODE</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="postal" class="validate[required]" id="field-reg-postal"/>
                        </td>
                        <td class="mycart-reg-separator"></td>
                        <td class="mycart-reg-field">POSTAL CODE</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="postal_s" class="validate[required]" id="field-reg-postal_s"/>
                        </td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">PHONE</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="phone" class="validate[required,custom[phone]]" id="field-reg-phone"/>
                        </td>
                        <td class="mycart-reg-separator"></td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">EMAIL</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <input name="email" class="validate[required,custom[email]]" id="field-reg-email"/>
                        </td>
                        <td class="mycart-reg-separator"></td>
                    </tr>
                    <tr class="mycart-reg-wrap">
                        <td class="mycart-reg-field">ADDITIONAL INFORMATION</td>
                        <td class="mycart-reg-dcollon">:</td>
                        <td class="mycart-reg-input">
                            <textarea name="additional" ></textarea>
                        </td>
                        <td class="mycart-reg-separator"></td>
                    </tr>
                </table>
                <div class="_blank" style="height:70px;"></div>
                <table width="100%">
                    <tr>
                        <td>
                            <a href="<?php echo base_url();?>cart">
                                <img src="<?php echo base_url();?>images/back-button.png" />
                            </a>
                        </td>
                        <td class="right">
                            <input type="image" src="<?php echo base_url();?>images/purchase-button.png" />
                        </td>
                    </tr>
                </table>
            </form>
        </div>
        <div class="clear"></div>
    </div>
    <div class="clear"></div>
    <div id="footer" class="footer-cart">
        <p>ABOUT | TERMS & CONDITION</p>
        <p>©2012-2013 website design by SANROK Studio</p>
    </div>
</div>